NCDVTMH Review of Trauma-Specific Treatment in the Context of Domestic Violence

Experiencing domestic violence can have significant mental health consequences. For many survivors, the traumatic effects of abuse can be alleviated with increased safety and support. For others, trauma-specific mental health interventions have proven helpful, particularly when provided in conjunction with domestic violence advocacy.

Yet, while awareness of the impact of trauma has grown considerably, access to mental health or substance abuse services of any kind is often limited, much less services that are gender responsive, culturally relevant, trauma informed, and trauma specific. Additional barriers to services exist for survivors who do not speak English or are undocumented, or for whom accessing behavioral health services carries a high level of stigma.

Despite these limitations, some DV advocacy programs provide trauma treatment to survivors within their agencies, and others are in a position to assist survivors in accessing DV-informed, trauma-specific services in their communities. Advocates may also be engaged in collaborative relationships with mental health providers through which they have opportunities to infuse a DV perspective into existing mental health approaches. For these reasons, it is helpful for the DV field to be aware of the types of trauma treatments that are currently available, particularly models that are specifically tailored for survivors of domestic violence, and to be aware of both the strengths and limitations of existing evidence-based treatments for trauma in the context of DV.

While there are numerous interventions designed to reduce trauma-related mental health symptoms, most were originally developed to address events that have occurred in the past. Many domestic violence survivors are still under threat of ongoing abuse or stalking, which not only directly impacts their physical and psychological safety but impacts treatment options as well. Little has been known about the extent to which existing evidence-based trauma treatment modalities are applicable to, or require modification for, IPV survivors.

In order to address these concerns, NCDVTMH, in collaboration with Cris Sullivan, PhD, and Echo Rivera, MA, at Michigan State University, conducted a formal literature review of evidence-based trauma treatments for survivors of domestic violence. The paper, A Systematic Review of Trauma-Focused Interventions for Domestic Violence Survivors (see link below) provides an analysis of nine trauma-based treatments specifically designed or modified for survivors of DV, along with caveats and recommendations for research and practice going forward.

Key findings included the following: Trauma treatments that have been modified to meet the specific needs of IPV survivors hold promise for helping women recover and successfully move on with their lives. Additional research is needed to address the domains not examined by these studies, particularly for survivors who have experienced multiple forms of trauma and for survivors from culturally specific communities. While it is too early to know definitively which treatments work best for which survivors, evidence suggests that helpful components may include (1) psychoeducation about the causes and consequences of IPV and its traumatic effects; (2) attention to ongoing safety; (3) cognitive and emotional skill development to address trauma-related symptoms and other life goals and concerns; and (4) a focus on survivors’ strengths as well as cultural strengths on which they can draw.

In addition, there are a number of approaches that fall under the rubric of “complex trauma treatment.” Based originally on the work of Judith Herman, MD, in her 1992 book, Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror, complex trauma models offer a more comprehensive framework for understanding and responding to the various effects of chronic abuse as well as a more flexible multi-modal treatment approach. To date, none have been specifically tailored to or studied for survivors of domestic violence. In the long run, however, these models may ultimately prove to be especially useful to DV survivors, particularly those whose experiences of abuse have been more prolonged and severe. Complex trauma treatment models also tend to be consistent with many elements of trauma-informed practice, including addressing safety as a priority, recognizing that symptoms may be coping strategies, and stressing the importance of respectful, collaborative relationships in supporting healing and recovery (Harris, 1998; Saakvitne, Gamble, Pearlman, & Lev, 2000). More holistic, culturally specific approaches for responding to the intersections of individual and collective trauma have also not been studied for survivors of DV.

Given that IPV survivors have a wide variety of life experiences with a range of mental health effects, there is no single treatment model that will fit the needs of all. A great deal more research is needed to understand how to respond most effectively to survivors with such a diverse range of needs and experiences.

NCDVTMH is engaged in ongoing work to help build an evidence base for trauma-informed and trauma-specific interventions in the context of domestic violence in collaboration with the DV field. Over the next two years, we will be identifying and sharing information about promising practices, conducting focus groups with advocates and survivors from diverse communities about trauma-related outcomes that are meaningful to them and the responses and interventions they find most helpful, and engaging trauma researchers and clinicians in talking with us about their work and its applicability for survivors who are experiencing ongoing abuse by an intimate partner.